All of my Disabilities add up to more than 100%. Why does va say i'm only 100%?
Each disability rating granted by VA has a minimum and maximum rating. When they are combined, they do not use conventional math... rather they use what many people call "VA math" to determine how disabled a person is. Here's how VA Math works:
List the ratings from largest to smallest, In this example, we'll use a fictional veteran with a 70%, 40%, 20%, 10%, 10% and 0%.
A person with no disabilities is considered 100% able. Take 70% from that, and you have a person who is 30% able.
The 30% able person has another service connection that is 40%. 40% of 30 is 12, which leaves 18%.
The 18% able person has another service connection that is 10%. 10% of 20 is 1.8, which leaves 16.2%.
The 16.2% able person has another service connection that is 10%. 10% of 16.2 is 1.62, which leaves 14.58%
The 14.58% able person has another service connection that is 0%, which only provides service connection for a condition or issue that does not meet the criteria for a higher designation.
With the final percent able of 14.58%, that leaves the veteran 85.42% disabled, which is rounded up to 90%.
List the ratings from largest to smallest, In this example, we'll use a fictional veteran with a 70%, 40%, 20%, 10%, 10% and 0%.
A person with no disabilities is considered 100% able. Take 70% from that, and you have a person who is 30% able.
The 30% able person has another service connection that is 40%. 40% of 30 is 12, which leaves 18%.
The 18% able person has another service connection that is 10%. 10% of 20 is 1.8, which leaves 16.2%.
The 16.2% able person has another service connection that is 10%. 10% of 16.2 is 1.62, which leaves 14.58%
The 14.58% able person has another service connection that is 0%, which only provides service connection for a condition or issue that does not meet the criteria for a higher designation.
With the final percent able of 14.58%, that leaves the veteran 85.42% disabled, which is rounded up to 90%.
how do copays work with va healthcare? who pays what?
This can be a complicated question to answer, but only because there are different factors involved.
If you have a service-connected disability and receive healthcare through the VA with no copay, you should never give any other insurance information to any medical facility or practitioner. If there is anything for you to pay, VA will bill you. If you receive a bill from anyone BUT VA, they did the billing wrong and will have to pay that money back before refiling the paperwork.
If you have a service-connected disability and receive healthcare through the VA with a copay due to your income, the same applies. NEVER give any other information to the medical facility or practitioner... all you give them is your VA information. If you don't have prior authorization for community care, such as in the event of an emergency, make sure you contact your Primary Care Provider or VA within 72 hours so that they can approve payment. The veteran does not have to be the one to do this if they are unable to for any reason. A family member can be the one to contact VA, which they can do using the information on the veteran's VA Healthcare ID card.
If you do not have a service-connected disability and receive healthcare through the VA with or without a copay, guess what.... you still only provide your VA healthcare information. Prior authorization is still required or notification within 72 hours in the case of an emergency.
Some veterans with VA healthcare have another health insurance policy. The information for this policy should be on record with VA so that they can bill your secondary insurance. VA healthcare is ALWAYS the primary for medical billing.
Example: Veteran has 20% service-connection. Still pays for health insurance that they purchased before being enrolled in VA Healthcare. When they go to a VA appointment, VA bills their outside health insurance and the veteran only pays co-pays for their medication.
Example: Veteran enrolled in VA healthcare needs services that are not available in their local VA Healthcare system. Their care is then directed toward the Veteran's Choice program, which is run through TriWest. An authorization is provided to the veteran so that they can give a copy to each of the entities that will bill them for related care. All care paid for in this manner must be mentioned on the authorization. If it is not, the veteran will need to contact their Primary Care Provider to get a determination of whether or not the doctor is asking for something that is a) medically necessary for treatment and b) not available in the local VA healthcare system. An example of this would be an oncologist ordering a colonoscopy or genetic testing.
Example: Veteran has no service-connection, but is enrolled in VA healthcare due to income. Veteran is also on Medicare. This veteran has to go to the hospital in an emergency, and the hospital is given only their VA information. The hospital takes it upon themselves to bill Medicare for this veteran's emergency healthcare and sends the veteran a bill for the balance. This veteran contacts VA, who helps them in correcting the hospital. The hospital ends up having to repay Medicare for the billing error and refile their paperwork. Situations like this can be very stressful for the veterans and their families, so don't hesitate to contact a veteran's advocate like your local Post Service Officer for assistance in understanding it or getting it straightened out.
The only time that a veteran with VA healthcare will see their outside health insurance billed is if they are being treated for a non-service-connected condition. Medicare can not be billed for care received in a VA facility, but Medicare supplemental insurance can and will.
For more information related to this discussion, please visit U. S. Department of Veterans Affairs: Health Care Insurance.
If you have a service-connected disability and receive healthcare through the VA with no copay, you should never give any other insurance information to any medical facility or practitioner. If there is anything for you to pay, VA will bill you. If you receive a bill from anyone BUT VA, they did the billing wrong and will have to pay that money back before refiling the paperwork.
If you have a service-connected disability and receive healthcare through the VA with a copay due to your income, the same applies. NEVER give any other information to the medical facility or practitioner... all you give them is your VA information. If you don't have prior authorization for community care, such as in the event of an emergency, make sure you contact your Primary Care Provider or VA within 72 hours so that they can approve payment. The veteran does not have to be the one to do this if they are unable to for any reason. A family member can be the one to contact VA, which they can do using the information on the veteran's VA Healthcare ID card.
If you do not have a service-connected disability and receive healthcare through the VA with or without a copay, guess what.... you still only provide your VA healthcare information. Prior authorization is still required or notification within 72 hours in the case of an emergency.
Some veterans with VA healthcare have another health insurance policy. The information for this policy should be on record with VA so that they can bill your secondary insurance. VA healthcare is ALWAYS the primary for medical billing.
Example: Veteran has 20% service-connection. Still pays for health insurance that they purchased before being enrolled in VA Healthcare. When they go to a VA appointment, VA bills their outside health insurance and the veteran only pays co-pays for their medication.
Example: Veteran enrolled in VA healthcare needs services that are not available in their local VA Healthcare system. Their care is then directed toward the Veteran's Choice program, which is run through TriWest. An authorization is provided to the veteran so that they can give a copy to each of the entities that will bill them for related care. All care paid for in this manner must be mentioned on the authorization. If it is not, the veteran will need to contact their Primary Care Provider to get a determination of whether or not the doctor is asking for something that is a) medically necessary for treatment and b) not available in the local VA healthcare system. An example of this would be an oncologist ordering a colonoscopy or genetic testing.
Example: Veteran has no service-connection, but is enrolled in VA healthcare due to income. Veteran is also on Medicare. This veteran has to go to the hospital in an emergency, and the hospital is given only their VA information. The hospital takes it upon themselves to bill Medicare for this veteran's emergency healthcare and sends the veteran a bill for the balance. This veteran contacts VA, who helps them in correcting the hospital. The hospital ends up having to repay Medicare for the billing error and refile their paperwork. Situations like this can be very stressful for the veterans and their families, so don't hesitate to contact a veteran's advocate like your local Post Service Officer for assistance in understanding it or getting it straightened out.
The only time that a veteran with VA healthcare will see their outside health insurance billed is if they are being treated for a non-service-connected condition. Medicare can not be billed for care received in a VA facility, but Medicare supplemental insurance can and will.
For more information related to this discussion, please visit U. S. Department of Veterans Affairs: Health Care Insurance.
i have another question that isn't answered here. what should I do?
No problem. All you have to do is contact our Post Service Officer. If we don't know the answer, we can find it for you. Just pay a visit to our contact page, fill out the form and send it in or call the Post.
How do I transfer my hazlewood benefits to my child?
You can not transfer the benefit ahead of time. In order for a child to use it as a Legacy, they need proof of the eligibility of the parent whose benefit they are using and must be already enrolled in a qualifying institution of higher learning. If you want to put a packet together for your child or spouse to use in the event of your demise, the best thing to do is make sure that you have all of the paperwork required in an envelope or folder. Make sure to put it somewhere safe so it will be ready for them should the situation arise. Your Post Service Officer can help you with this if you would like.
Find out more at the Texas Veterans Commission.
Find out more at the Texas Veterans Commission.